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Individuals with more risk episodes had lower composite cognitive function ( 0.001), psychomotor speed ( 0.001), and executive function ( = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors. In this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to pre